Provider Demographics
NPI:1003620352
Name:MEST, SHANNON NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:NICOLE
Last Name:MEST
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 ROUTE 20A
Mailing Address - Street 2:
Mailing Address - City:STRYKERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14145-9560
Mailing Address - Country:US
Mailing Address - Phone:716-343-5036
Mailing Address - Fax:
Practice Address - Street 1:911 ROUTE 20A
Practice Address - Street 2:
Practice Address - City:STRYKERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14145-9560
Practice Address - Country:US
Practice Address - Phone:716-343-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor